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View all search resultsAs hospital bills climb, consumers may bear the final cost
Soaring medical claims would force private insurers to raise premiums, ultimately squeezing individual policyholders and employers, who may either cut coverage or pass costs on to workers.
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The BPJS has stopped covering trastuzumab for patients treated under its state-funded National Health Insurance-Healthy Indonesia Card (JKN-KIS) scheme since April 1, arguing that the medication’s effectiveness was not empirically proven. (Shutterstock/File)
“I didn’t question the costs at the time. When you’re sick, you just follow what the doctors say and focus on getting treated,” said Sukma, a 42-year-old private sector worker in Jakarta, to The Jakarta Post on Wednesday.
A hospital charged about Rp 60 million (US$3,550) for an endoscopy and colonoscopy to examine Sukma's stomach pain, with about a third of the bill going to drugs and medical supplies during a three-day stay, most of it covered by insurance.
Initially diagnosed with Crohn’s disease, she was prescribed medication costing up to Rp 8 million a month. But with insurance covering only 30 days of post-treatment care, she had to pay for the remaining months herself.
“Strangely, the drug was also hard to find and seemed to be available only at that hospital,” she said.
After seeking a second opinion three months later, Sukma said she was told the condition was likely irritable bowel syndrome and pancreatitis, and that the colonoscopy had not been necessary, leaving her frustrated by the costly procedures and treatment she had already undergone.
Sukma's experience is an example of how medical bills submitted by service providers, such as hospitals, to private insurers are drawing scrutiny for being priced far above their underlying costs. If left unaddressed, industry players say the practice could push up claims and eventually add pressure on both consumers and employers.
“The mark-up of hospital bills and rising claims are fueling medical inflation, forcing insurers to raise premiums,” insurance analyst Irvan Rahardjo told the Post on Friday.
